Should You Have Back Surgery?

For those who live with back pain, surgery has always been held out as the last resort when more conserva­tive, less-invasive treatments fail. In emer­gency situations, as in the case of cauda equina syndrome, surgery is a no-brainer; it is the only way to stave off permanent, serious nerve damage. In other situations, the choice is less clear-cut. Only a small minority of patients require surgery, and studies have found no clinically meaningful difference in outcomes between patients who got certain surgeries and those who got a nonsurgical treatment.

Bear in mind that back surgery is, gener­ally speaking, elective. The following are the key two questions to consider initially:

Has your pain been severe or debili­tating for at least six weeks, during which nonsurgical therapies have failed to provide adequate relief?

Is there clear evidence that the underlying cause of your pain can be treated surgically? Your doctor should be able to present clear evidence—or at least very compelling clues—that your pain is a direct result of a surgically treatable condi­tion such as spinal stenosis, spondylolisthe­sis, herniated disc, vertebral compression fractures, or some other condition (such as certain degenerative spinal diseases) ame­nable to surgical intervention.

As with any surgery, there are risks. These include infection at the site of the incision, severe bleeding, nerve damage or paralysis, bad reactions to the anesthesia, the formation of blood clots that can travel to the lungs, heart attacks, and even death. Such risks are quite rare but should none­theless be factored into the decision process.

Your doctor should be able to help you weigh your own individual risks against the potential benefits. Current clinical guide­lines emphasize that “shared decision-making” between doctor and patient generally produces the most satisfactory outcomes. When thoughtful shared deci­sion-making is part of the equation, people generally are less likely to opt for surgery.